Melasma is a chronic skin pigmentation condition characterized by brown or gray patches on sun-exposed areas of the face. It predominantly affects women and individuals with darker skin types. This case study examines the efficacy and safety of platelet-rich plasma (PRP) injections as an adjunct treatment for melasma alongside conventional therapies. Two female patients with mixed melasma on the cheeks were treated with topical depigmenting agents, Q-switched laser treatments, and monthly PRP injections over 6-12 months. Both experienced mild side effects from the PRP therapy with no major complications. Improvement in melasma pigmentation was observed, though recurrence remained an issue, particularly for those with higher Fitzpatrick skin types.

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2. Introduction
• Melasma is a pigmentary and chronic disease which
is diagnosed by detection of brown or gray patches
on sun exposed areas of the face including forehead,
nose, malar and mandibular (1).
• Commonly seen in women especially those with
darker skin tone.
• Melasma can be histologically classified into three
types according to the deposition of the hyperactive
melanocytes at the epidermal, dermal or mixed type
(both epidermal and dermal layer).
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3. • The prevalence of melasma in the general
population varies according to geographical
locations and race. A prevalence of 8.8% in
Hispanic women, 40% in South East Asian women
and 20% in men have been reported (2,3). Melasma
mostly affects women with Fitzpatrick phototypes
III through VI.
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Introduction

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Introduction
Melasma Area and Severity Index MASI Score

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Introduction
PRP is a product of whole blood that has high
concentration of platelets. It contains a number of
different growth factors and other cytokines release
through degranulation and stimulate healing of hard
and soft tissues . Seven growth factors and three
adhesion molecules had shown to exhibit higher
concentration in PRP compared to whole blood.
Thus, accelerating cell regeneration at the site of
injection as well as during its topical application.

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Introduction
Currently there is no randomized case controlled
study or trial done using platelet rich plasma (PRP)
therapy in treating pigmentation conditions or
melasma. Therefore this case study try to
demonstrate the efficacy and safety of intradermal
PRP injection in adjunct to the conventional
therapies of mixed melasma such as topical
depigmenting agents, chemical or Q-switched Nd
Yag laser in Asian patients.

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Cases Presentation
Subject 1 profile:
- 42 year old female with
- Fitzpatrick skin type IV.
- no known medical illness
- did not take any oral contraceptive pill (OCP)
- no hormone replacement therapy (HRT)
- no significant aesthetic/surgical history
-She came with the complaint of having few patches
of brown pigmentation on her both cheek for about
10 years but worsening for the past few years.

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Cases Presentation
- Clinical examination showed that few patches of
brown pigment macule on both malar and temporal
area suggestive of mixed melasma.
- 3 to 4 small bluish brown macules on her both cheeks
which might be Hori nevus.
- was given depigmenting agents Pro-heal Serum (IS
Clinic Products) which contains topical alpha arbutin
twice daily and started on 1064nm Q-switched Nd Yag
laser (Conbio RevLite) at 10Hz, spot size of 8mm, at the
fluence of 2.0-2.3J/cm2 for 2 passes then spot size of
6mm at 3.0-3.6J/cm for 2 to 4 passes in monthly interval

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Cases Presentation
- However her melasma pigmentation was not
improving. Hence intradermal injection of PRP
was added as adjunctive therapy to the above
therapies started since Dec 2012 at monthly
interval.

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Bac

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Subject 2 profile:
- 51 year old female
- no known medical illness
- Fitzpatrick skin type V.
- no OCP, HRT, anti-convulsant or thyroid
medications.
- no significant aesthetic/surgical history
- She concerned about the large patches of brown
pigmentation on her both cheeks for about 15
years.
Cases Presentation

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- Clinical assessment showed irregular brown
pigment macules over both malar areas with
telangiectasia suggestive of mixed melasma.
- treated with laser at other centre with no
improvement.
- given topical Pro-heal Serum (IS Clinic Products)
contains alpha arbutin twice daily and started on
1064nm Q-switched Nd Yag laser (Conbio RevLite)
at 10Hz, spot size of 8mm at the fluence of 1.8-
2.1J/cm2 for 2 passes then spot size of 6mm at 2.8-
3.1J/cm for 2 to 4 passes in monthly interval from
June 2013 to September 2013.
Cases Presentation

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- In view of her concern of dry skin with fine lines
and telangiectasia, intradermal injection of PRP
was offered for the pigmentation area accompany
the above Q-switched laser session at monthly
interval since June 2013.
Cases Presentation

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The side effects and complications observed in this case
study were minimal and tolerable to the subjects with the
application of local anesthetic cream thoroughly,
meticulous injection techniques and application of the
cooling mask or cold compression. Both subjects
experienced mild erythema, edema and small needle prick
mark bruises for the first few days after the PRP therapy.
The erythema and edema were resolved within one to two
days. The bruises were lasted slightly longer for about 4
to 5 days if the injections of the PRP had injured some of
the small blood vessels.
Results

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In the 3 months follow up, the recurrence or rebound of
melasma for subjects 2 was as high as mean MASI score
53% which was higher than other study. This might be
due to the loss of inhibitory effects of melanogenesis by
PRP therapy in which the PRP effects is transient and the
growth factors released once in a time. The recurrence
melasma also would be more common for higher
Fitzpatrick skin type patients which had been reported in
other studies.
Results

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Melasma is common among the Asian female
population in which they are resistance to the
conventional therapies. It is advisable for the
melasma patients to have maintenance therapy to
prevent recurrence of the melasma especially in the
higher Fitzpatrick skin type patients.
Conclusion

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In this case study, minimal side effects were observed
in the intradermal PRP injection including pain,
erythema, oedema and bruises. PRP therapy which
serves as a source of different growth factors might
help to reduce the pigmentation of melasma in some
cases via the alternative biochemical pathway
synergistic to the conventional therapies.
Conclusion

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Nevertheless, this case study can be served as a pilot
study for using PRP injection to treat melasma in
adjunct to other conventional melasma therapies. It
will be more benefit to the melasma patients if there
are multi-centre studies done in larger sample size
with control group to evaluate the effect of PRP
injection in melasma patients with the different skin
types.
Conclusion

21. Thank You
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